October 6, 2015

Gingival Grafts

Gingival grafting comes in two different forms:

1 – Augmentation Gingival Grafting to Treat Recession
2 – Connective Tissue Grafting for Cosmetic Improvement

1 – Augmentation Gingival Grafting to Treat Recession

In health, there are two types of gum tissues that surround the tooth. The part that is around the neck of the tooth is firmly attached to the tooth and underlying bone, and is called attached gingiva. The attached gingiva is immovable and tough, and deflects food as it hits the gum. Below the attached gingiva is looser gum, or alveolar mucosa. This tissue contains muscle, and is flexible to allow movement of the cheeks and lips. The muscles in the alveolar mucosa are constantly contracting, which pulls on the bottom edge of the attached gingiva. However, normally the attached gingiva is wide and strong enough to act as a barrier, which prevents the gum from being pulled down (receding).

Gingival grafting1

Some people are born without sufficient attached gingiva to prevent the muscle in the alveolar mucosa from pulling the gum down. In these cases the gum slowly continues to recede over time, even though the patient may be very conscientious with their oral health. This is not an infection, as is seen with periodontal disease, but rather simply an anatomic condition. Unfortunately, bone recession is occurring at the same time the gum is receding. This is because the bone, which is just under the gum, will not allow itself to become exposed to the oral cavity and moves down with the gum.

Gingival grafting2

With the wear and tear of time, even normal attached gum can be worn away, generally from vigorous brushing. This often happens in people with naturally thin tissues, or when the tissues have been stretched during orthodontics. If there is still adequate attached gum to act as a barrier to the muscle, the treatment for recession is to ensure further damage isn’t done when brushing. However, if the attached gum is worn to the point where it cannot resist the constant pull of the mucosa, recession will continue unless a new hard band of gum is placed. Unchecked, the recession can cause tooth loss as the bone recedes with the tissue and tooth support weakens.

Gingival grafting3

The gingival graft procedure begins by resecting the tissue that is pulling down on the edge of gum adjacent to the tooth and repositioned away from the gum margin. A piece of keratinized tissue is removed from the roof of the mouth. Alternately off the shelf tissue in the form of freeze-dried skin is also available which eliminates the need for tissue from the palate. The new tissue is transplanted to the prepared site and sutured in place. The new tissue reattaches and reforms a new layer of attached gum. This tissue should last a lifetime with proper care.

2 – Connective Tissue Grafting for Cosmetic Improvement

These free gingival or augmentation gingival grafts do not cover the exposed root surface. When root coverage for cosmetic or issues of sensitivity is desired the connective tissue graft is needed. See Cosmetic Procedures for examples